1. Field of the Invention
The present invention relates generally to the field of endoscopic devices, and more particularly, to laparoscopic surgical devices including laparoscopic ports which provide minimally invasive access to the abdominal cavity.
2. Description of the State of the Art
Endoscopic surgery has become the new standard for surgical procedures. A specific type of endoscopic surgery, laparoscopic surgery, has become the preferred method for surgeries involving the organs within an abdominal cavity or peritoneal cavity of a patient.
Laparoscopic surgery employs small incisions appropriately placed on a patient's abdomen instead of one large incision as was the custom in traditional laparotomies or “open” surgeries. Instruments are inserted through these small incisions, and the surgery is performed via the manipulation of these instruments.
Laparoscopic ports are employed to provide effective access to the abdominal cavity. Such ports maintain an air-proof seal and to facilitate the insertion of medical devices into the incisions. Multiple incisions and multiple laparoscopic ports allow the simultaneous use of different instruments including a laparoscope, which displays images on a video display in order to guide the surgeon. The port through which the laparoscope is inserted is commonly referred to as the primary port, while ports for the other instruments are referred to as ancillary ports.
Many laparoscopic ports, also known as laparoscopic access systems, involve a cannula, which is a hollow tube, and a removable trocar, which is inserted through the cannula to facilitate insertion of the cannula through the abdominal wall. The distal tip of a trocar may be either sharp or blunt. The external opening of the cannula through which instruments are inserted is often referred to as the entry port of the cannula and the opening at the tip of the cannula through which the instrument emerges inside the peritoneal cavity is referred to as the exit port.
One of the first steps during a laparoscopic surgical procedure involves insufflation of the abdomen with nitrogen or carbon dioxide gas. The resulting expansion of the abdomen reduces the risk of injury to the contents of the abdomen during subsequent insertion of the ports and also allows the surgeons more freedom and space to manipulate instruments and perform the surgery.
Insertion of the primary port is accomplished either blindly or through the use of a device that allows some visualization through the laparoscope's camera as the tip of the trocar penetrates the abdominal wall. Insertion of the ancillary ports is generally accomplished while using a laparoscope at the primary port to observe the peritoneum at the ancillary point of insertion. Such observation reduces the risk of damaging abdominal organs beneath the point of insertion, such as may occur when the trocar is pushed to far into the abdominal cavity.
Laparoscopic surgery is generally performed with only one source of visualization, namely, the camera at the tip of the laparoscope. However, in order to minimize risk of injury to the patient, it is preferable to observe the exit ports of all cannulas every time an instrument is inserted or withdrawn. Such observation currently requires that the camera on the tip of the laparoscope be directed toward a particular port. This would then result in the loss of visualization of the surgical field, which interrupts the surgical procedure and interrupts the use of the surgical instruments until the surgical field can again be visualized with the laparoscope.
In addition, sometimes during the course of a surgery an endoscopist or surgeon determines that the view through the laparoscope is not optimal for safe manipulation of the instruments, and it is necessary to withdraw the laparoscope from the primary port and insert it through one of the ancillary ports in order to provide visualization of the surgical field from a more appropriate angle. This also interrupts the surgical procedure and increases risk to the patient.
Therefore, it is desirable to have multiple concurrent views of the surgical field. With currently available technology, the only way to provide such visualization would be through the insertion of a second laparoscope. However, because laparoscopes are relatively long and heavy, a surgeon or an assistant must have one hand occupied with the laparoscope at all times unless it is attached to a robotic arm. Furthermore, laparoscopes require sterilization between uses, and using more than one laparoscope for a procedure would result in significant additional expense for sterilization. Additionally, because many laparoscopes have cameras with a nonadjustable viewing angle, multiple laparoscopes, each having a different viewing angle, are often required to be exchanged during a surgical procedure. Because laparoscopes are very expensive, using more than one laparoscope for a surgical procedure would require a hospital or surgical facility to make a substantial additional investment to have extra laparoscopes on hand, which also requires increases maintenance and sterilization expenses.
Therefore, there exists a need for a more practical and less expensive method of providing multiple concurrent views of a surgical field. There is also a need for a more efficient method of viewing the insertion point of ancillary ports through the peritoneum and of viewing insertion and withdrawal of surgical instruments at the ancillary ports. Further, there exists a need to reduce manipulation and exchange of laparoscopes and other endoscopic instruments during minimally invasive procedures, which would reduce the time required to complete the procedure, limit the overall cost, and reduce patient risk. The present invention satisfies these and other needs.